Difference between revisions of "Pituitary gland"

Jump to navigation Jump to search

Pituitary gland (view source)

Revision as of 11:30, 30 September 2022

600 bytes added ,  11:30, 30 September 2022
→‎Pituitary carcinoma: Update
 
(7 intermediate revisions by the same user not shown)
Line 69: Line 69:


=DDx for sella turcica lesions=
=DDx for sella turcica lesions=
*[[Pituitary adenoma]].
*[[Pituitary adenoma|PitNET]].
*[[Rathke cleft cyst]].
*[[Rathke cleft cyst]].
*[[Craniopharyngioma]].
*[[Craniopharyngioma]].
Line 89: Line 89:
=Specific entities=
=Specific entities=
==Pituitary neuroendocrine tumor (PitNET)==
==Pituitary neuroendocrine tumor (PitNET)==
Old terminology '''Pituitary adenoma''' is depreceated
Old terminology '''Pituitary adenoma''' is depreceated.
The WHO 2022 Classification of tumours of endocrine organs recoginizes following tumours:<ref>{{cite journal |vauthors=Asa SL, Mete O, Perry A, Osamura RY |title=Overview of the 2022 WHO Classification of Pituitary Tumors |journal=Endocr Pathol |volume=33 |issue=1 |pages=6–26 |date=March 2022 |pmid=35291028 |doi=10.1007/s12022-022-09703-7 |url=}}</ref>
 
 
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! PitNET lineage
! PitNET type
! subtypes
! Hormone IHC
! Transcription factor IHC
|-
| PIT1
| Somatotroph tumor
| Densely and sparsely granulated tumor
| GH, a-subunit+/-, CK+
| PIT1
|-
| PIT1
| Lactotroph tumor
| Densely and sparsely granulated tumor
| PRL, CK-ve or weak
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Mammosomatotroph tumor
|
| GH, PRL (usu. less), CK perinuclear +ve
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Thyrotroph tumor
|
| TSH, CK-ve or weak
| PIT1, GATA3
|-
| PIT1
| Mature plurihormonal PIT1 lineage tumor
|
| GH, PRL, TSH, a-subunit +/-ve, CK perinuclear
| PIT1, [[Estrogen receptor|ER]], GATA3
|-
| PIT1
| Immature PIT1 lineage tumor
|
| Only focal GH, PRL, TSH, a-subunit +/-ve, CK variable
| PIT1, [[Estrogen receptor|ER]] +/-ve, GATA3 +/-ve
|-
| PIT1
| Acidophilic stem cell tumor
|
| PRL, GH (focal/variable), CK fibrous bodies
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Mixed somatotroph and lactotroph tumor
|
| PRL, GH (in separate cells)
| PIT1, [[Estrogen receptor|ER]] (only in lactotroph component) 
|-
| TPIT
| Corticotroph tumor
| Densely and sparsely granulated tumors, Crooke cell adenoma
| ACTH,CK+ve
| TPIT
|-
| SF1
| Gonadotroph tumor
|
| FSH, LH, a-Subunit or none
| SF1, ER, GATA3, CK+/-ve
|-
| None
| Plurihormonal tumor
|
| All combinations possible
| All combinations possible, CK+/-ve
|-
| None
| Null cell adenoma
|
| None (adenohypophyseal?)
| None
|}
 
Other tumours may be classified as plurhormonal or double adenomas or as adenomas with unusual IHC combination.
 
===General===
===General===
*Clinical:<ref>{{Ref PBoD8|1100}}</ref>
*Clinical:<ref>{{Ref PBoD8|1100}}</ref>
Line 97: Line 182:


Morphologic Classification:
Morphologic Classification:
#Microadenoma <= 1 cm.
#Microtumor <= 1 cm.
#Macroadenoma 1-4 cm.
#Macrotumor 1-4 cm.
#Giant adenoma > 4cm.
#Giant tumor > 4cm.


May be classified by what they secrete.  
May be classified by what they secrete.  
Line 148: Line 233:
*Basophilic cells (corticotrophs).
*Basophilic cells (corticotrophs).
*Eosinophilic cells(somatotrophs).
*Eosinophilic cells(somatotrophs).
*Extensive fibrosis often seen in TSH-producing tumors.


Notes:
Notes:
*Smears very well.<ref>MUN. 24 November 2010.</ref>
*Smears very well.<ref>MUN. 24 November 2010.</ref>
The WHO 2022 Classification of tumours of endocrine organs recoginizes following tumours:<ref>{{cite journal |vauthors=Asa SL, Mete O, Perry A, Osamura RY |title=Overview of the 2022 WHO Classification of Pituitary Tumors |journal=Endocr Pathol |volume=33 |issue=1 |pages=6–26 |date=March 2022 |pmid=35291028 |doi=10.1007/s12022-022-09703-7 |url=}}</ref>
{| class="wikitable sortable" style="margin-left:auto;margin-right:auto"
! PitNET lineage
! PitNET type
! subtypes
! Hormone secretion
! Transcription factor
|-
| PIT1
| Somatotroph tumor
| Densely and sparsely granulated tumor
| GH, a-subunit+/-, CK+
| PIT1
|-
| PIT1
| Lactotroph tumor
| Densely and sparsely granulated tumor
| PRL, CK-ve or weak
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Mammosomatotroph tumor
|
| GH, PRL (usu. less), CK perinuclear +ve
| PIT1, [[Estrogen receptor|ER]]
|-
| PIT1
| Thyrotroph tumor
|
| TSH, CK-ve or weak
| PIT1, GATA3
|-
| PIT1
| Mature plurihormonal PIT1 lineage tumor
|
| GH, PRL, TSH, a-subunit +/-ve
| PIT1, [[Estrogen receptor|ER]], GATA3
|-
|
| Corticotroph adenoma
| Densely and sparsely granulated adenoma, Crooke cell adenoma
| ACTH,CAM 5.2
| TPIT
|-
|
| Gonadotroph adenoma
| Sparsely granulated adenoma
| FSH, LH or a-Subunit
| SF1, [[Estrogen receptor|ER]], GATA2
|-
|
| Null cell adenoma
|
| None
| None
|}
Other tumours may be classified as plurhormonal or double adenomas or as adenomas with unusual IHC combination.


====Images====
====Images====
Line 265: Line 288:
*Sparsely granulated somatotroph adenomas are more invasive than other variants and respond less to medical treatment. <ref>{{Cite journal  | last1 = Kato | first1 = M. | last2 = Inoshita | first2 = N. | last3 = Sugiyama | first3 = T. | last4 = Tani | first4 = Y. | last5 = Shichiri | first5 = M. | last6 = Sano | first6 = T. | last7 = Yamada | first7 = S. | last8 = Hirata | first8 = Y. | title = Differential expression of genes related to drug responsiveness between sparsely and densely granulated somatotroph adenomas. | journal = Endocr J | volume = 59 | issue = 3 | pages = 221-8 | month =  | year = 2012 | doi =  | PMID = 22200580 }}</ref>
*Sparsely granulated somatotroph adenomas are more invasive than other variants and respond less to medical treatment. <ref>{{Cite journal  | last1 = Kato | first1 = M. | last2 = Inoshita | first2 = N. | last3 = Sugiyama | first3 = T. | last4 = Tani | first4 = Y. | last5 = Shichiri | first5 = M. | last6 = Sano | first6 = T. | last7 = Yamada | first7 = S. | last8 = Hirata | first8 = Y. | title = Differential expression of genes related to drug responsiveness between sparsely and densely granulated somatotroph adenomas. | journal = Endocr J | volume = 59 | issue = 3 | pages = 221-8 | month =  | year = 2012 | doi =  | PMID = 22200580 }}</ref>
* Lactotroph adenomas in men may show aggressive clinical behavior. <ref>{{Cite journal  | last1 = Delgrange | first1 = E. | last2 = Vasiljevic | first2 = A. | last3 = Wierinckx | first3 = A. | last4 = François | first4 = P. | last5 = Jouanneau | first5 = E. | last6 = Raverot | first6 = G. | last7 = Trouillas | first7 = J. | title = Expression of estrogen receptor alpha is associated with prolactin pituitary tumor prognosis and supports the sex-related difference in tumor growth. | journal = Eur J Endocrinol | volume = 172 | issue = 6 | pages = 791-801 | month = Jun | year = 2015 | doi = 10.1530/EJE-14-0990 | PMID = 25792376 }}</ref>
* Lactotroph adenomas in men may show aggressive clinical behavior. <ref>{{Cite journal  | last1 = Delgrange | first1 = E. | last2 = Vasiljevic | first2 = A. | last3 = Wierinckx | first3 = A. | last4 = François | first4 = P. | last5 = Jouanneau | first5 = E. | last6 = Raverot | first6 = G. | last7 = Trouillas | first7 = J. | title = Expression of estrogen receptor alpha is associated with prolactin pituitary tumor prognosis and supports the sex-related difference in tumor growth. | journal = Eur J Endocrinol | volume = 172 | issue = 6 | pages = 791-801 | month = Jun | year = 2015 | doi = 10.1530/EJE-14-0990 | PMID = 25792376 }}</ref>
*Poorly differentiated PIT-1 positive adenomas may show aggresive growth. <ref> {{Cite journal  | last1 = Mete | first1 = O. | last2 = Gomez-Hernandez | first2 = K. | last3 = Kucharczyk | first3 = W. | last4 = Ridout | first4 = R. | last5 = Zadeh | first5 = G. | last6 = Gentili | first6 = F. | last7 = Ezzat | first7 = S. | last8 = Asa | first8 = SL. | title = Silent subtype 3 pituitary adenomas are not always silent and represent poorly differentiated monomorphous plurihormonal Pit-1 lineage adenomas. | journal = Mod Pathol | volume = 29 | issue = 2 | pages = 131-42 | month = Feb | year = 2016 | doi = 10.1038/modpathol.2015.151 | PMID = 26743473 }}</ref>
*Immature PIT-1 lineage tumors may show aggresive growth. <ref> {{Cite journal  | last1 = Mete | first1 = O. | last2 = Gomez-Hernandez | first2 = K. | last3 = Kucharczyk | first3 = W. | last4 = Ridout | first4 = R. | last5 = Zadeh | first5 = G. | last6 = Gentili | first6 = F. | last7 = Ezzat | first7 = S. | last8 = Asa | first8 = SL. | title = Silent subtype 3 pituitary adenomas are not always silent and represent poorly differentiated monomorphous plurihormonal Pit-1 lineage adenomas. | journal = Mod Pathol | volume = 29 | issue = 2 | pages = 131-42 | month = Feb | year = 2016 | doi = 10.1038/modpathol.2015.151 | PMID = 26743473 }}</ref>
 
===Molecular===
*GNAS mutations frequently in densely granulated somatotroph tumors.


==Pituitary blastoma==
==Pituitary blastoma==
Line 274: Line 300:


==Pituitary carcinoma==
==Pituitary carcinoma==
* ICD-O: 8272/3
* Depreceated in the WHO2022 classification.  
* Requires presence of cerebrospinal or systemic metastasis.
* It is acknowledged that PitNETs can be invasive or spread to other sites.
* Very rare.
* 75% are hormonally active (mostly PRL or ACTH).
* IHC: Synaptophysin, Chromogranin +ve


==Rathke cleft cyst==
==Rathke cleft cyst==
Jensflorian
Account-creators
1,040

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/52133...52142"

Navigation menu